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CPCS Study Guide Practice Test with complete solutions 2024_2025
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CPCS Study Guide Practice Test with complete solutions 2024_2025
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CPCS Study Guide Practice Test withcomplete solutions 2024/2025
Why is it important to check that the practitioner is not currently excluded,
suspended, debarred, or ineligible to participate in Federal health care programs?
- ANSWER-The facility won't get paid for treating patients unless service is
provided by an authorized provider.
Which of the following credentials must be tracked on an ongoing basis? -
ANSWER-Licensure
According to NCQA standards, an organization that discovers sanction
information, complaints, or adverse events regarding a practitioner must take
what action? - ANSWER-Determine if there is evidence of poor quality that could
affect the health and safety of its members.
What is the name of the entity that was established through the HealthCare
Quality Improvement Act of 1986 to restrict the ability of incompetent physicians,
dentists, and other health care practitioners to move from state to state without
disclosure or discovery of previous medical malpractice payment and adverse
action history? - ANSWER-The National Practitioner Data Bank
When developing clinical privileging criteria, which of the following is important
to evaluate? - ANSWER-Established standards of practice, such as specialty
board recommendations.
What is the main reason for periodically assessing appropriateness of clinical
privileges for each specialty? - ANSWER-It is required by the Medicare
Conditions of Participation.
, Which of the following specialists is most likely to perform a PTCA? - ANSWER-
Interventional Cardiologist
The Joint Commission hospital standards require that clinical privileges are
hospital specific and - ANSWER-Based on the individual's demonstrated current
competence and the procedures the hospital can support.
Which of the following would be routinely performed by a cardiologist? -
ANSWER-Transesophageal Echocardiography
Which NCQA-required committee makes recommendations regarding
credentialing decisions? - ANSWER-Credentialing Committee
HFAP standards require three medical staff committees to be delineated in the
medical staff structure. Two of them are the Medical Executive Committee and the
Utilization of Osteopathic Methods & Concepts Committee (required for hospitals
with ten or more DOs who admit patients and provide direct patient care). What is
the other required medical staff committee? - ANSWER-Utilization Review
Committee
How often does NCQA require that delegation reports be evaluated by the health
plan? - ANSWER-Semi-Annually
Peer references should be obtained from: - ANSWER-Practitioners in the same
professional discipline as the applicant
NCQA recognizes which of the following as the final approval of an applicant who
does not meet criteria for a clean file? - ANSWER-Credentialing Committee
If a medical staff member has privileges and/or medical staff appointment
revoked, he/she must be: - ANSWER-Provided due process.
Access to credentials files should be: - ANSWER-Described fully in an access
policy.
Which of the following bodies approves clinical privileges? - ANSWER-Governing
Body or Board
What primary source verification is required by NCQA prior to provisional
credentialing? - ANSWER-Licensure and 5-year malpractice history or NPDB
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